4th Glossy Nothing-to-see-here Don’t-worry-about-it Annual Report on Medical assistance in Dying 2022

A few months late, the 4th Annual was released to little fanfare. Here are a few thoughts and observations about what you might have missed.

We’ll start with their Chart 3.1 which documents the total number of medically assisted deaths in Canada since 2016: The total is 44,958

The smoothly increasing bars [are meant to] prove that this new way to die is becoming steadily more popular and that there’s nothing to worry about. However, we DO worry about it — a little or a lot. The numbers, when they were selling this to Canadians, were supposed to be and remain low. Canadians were not supposed to see this as an easy way out, but as a last resort, in extreme circumstances. However, this past year, 13,281 dying people chose it to reduce their chance of experiencing intolerable suffering (or for some other reason).

These numbers are rising exponentially — is that OK? Is Canada a place where a person with terminal cancer or heart issues can expect to be cared for with compassion and kindness until the very end of their natural lives? Or will there be pressure — months or years ahead — to follow the pack, reduce health-care costs and avoid burdening family by checking out early? Is that kind of pressure operating already? An editorial in the Globe and Mail this week raised the question of whether Canada is a safe place to get old, when according to the report’s Chart 4.1D, “frailty” is an acceptable reason to administer medically assisted death. We have no way of knowing from this report.

A couple of thin red bars on top of the final two bars seem to be almost incidental, hardly signalling an issue. Yet it was an interesting design choice to highlight the new category of non-dying people choosing doctor-assisted death in red. Those look like such tiny little insignificant bars on top of the huge bars of popularity upon which they rest. And yet, in our common experience, the colour red often signifies something that needs our attention — a sign or warning of danger. Those thin red bars signify euthanisia administered to people who were not dying. We believe that is a cause for grave concern and we want our readers — and our leaders! — to sit up and take notice.

Another chart offers quite a different picture:

We are not statisticians here at LWD, but to the ordinary eye, this chart is much less reassuring and soothing than the smooth bars of Chart 3.1. There are jagged spikes and wide discrepancies. These are the total MAID numbers by jurisdiction, i.e. by province or territory. Two places are clearly out of step with most other places in the country, with much higher growth rates and much steeper slopes. The flat purple line indicating the “average” would be at least two full points lower without these two spiky places.

Here is the key for interpreting this chart:

The provinces of Quebec and British Columbia are WAY above the other places. Yukon and the Northwest Territories are omitted because their numbers are so tiny. Those numbers, if included, would pull the “average” line down much further still.

These statistics and their presentation beg all kinds of important questions — political, sociological, legal, moral, constitutional — but the report presents them “objectively”. This may be something you’d like to take up with your MP, or your MPP who would be more involved with Provincial regulation issues, especially if you live in Quebec or BC. If you take this on, please let us know about your approach, how we might support you, and what kind of reception/response you get.

Meanwhile, we are presented with a report which is almost identical (just with higher numbers) to the 2021 report, our review of which you can check out here. But the new report itself highlights one notable change: “Practitioners involved in MAID have begun to specialize their practice, where some practitioners will only assess for MAID (i.e., not provide MAID), or will only accept MAID requests from persons whose natural death is reasonably foreseeable. This information is not collected through the federal MAID monitoring system.” We wonder why not?

Since the government report raises the issue of “doctor specialization”, we are reminded of another worrisome issue that jumped out at us last year, i.e. Doctors who do virtually nothing BUT assisted death. Again this year, here’s that problematic chart (Chart 5.3 in this year’s report):

Again, the colour choices are fascinating. Here, a bit strangely, the red colour is used for once-only doctors. Are these doctors a “problem” for not pushing MAID more? The 2-9 docs are portrayed with a reassuring blue. But the 10+ doctors receive the gold star on top of the heap, with absolutely no analysis of their numbers. This brings to mind Christopher Lyon’s recent Substack post, querying how we would know if there were serial killers on that list of “specialists”? Not that they all are, but how would we know?

Still worrisome again this year are the reasons given by people for choosing doctor-assisted death. Excruciating pain — the reason most people think of when they think of euthanasia — is once again only third on the list and then it doesn’t have to be real pain, only concern about pain; likewise symptoms, ranked at #5, don’t have to be real, only anticipated. Loss of ability to participate fully in activities or to perform some ADL’s (that’s Activities of Daily Living) prove to be the main reasons by far. In other words, some people would rather die than become disabled.

Meanwhile, the vast majority of people who ARE disabled and who DO need assistance with tasks of daily living, stand united in their opposition to T2 MAID for people with disabilities. They want assistance with the cost of assistance; they want assistance with clean, safe housing; they want assistance with barrier removal in employment, education, transportation, etc. They want timely and adequate access to mental health services without facing psychiatric incarceration. They want to be recognized as people whose lives are worth living.

Strangely, the percentage cited for “loneliness or isolation” stands at 17.1%, precisely the same as in 2021. In 2021, that meant 1,721 lonely people who died. In 2022, that number rises to 2,251 for a total of almost 4,000 people for whom death has been judged to be an appropriate response to a situation of loneliness. Do you find that appalling? It’s quite a contrast to the “died peacefully surrounded by loved ones” narrative sold to us in most media coverage of the MAID way of death. In 2022, 437 people cited emotional distress, existential suffering, fear and anxiety. 93 Canadians died for “other reasons”. What if we just found ways of caring for these lonely, isolated, fearful, distressed individuals instead? Too much to ask?

Let us come back to the smooth, reassuring chart with its thin red lines at the top of this post. Let us linger over the thirteen thousand individuals who shortened their process of dying — folks that include lonely, anxious people; frail elders; people with diseases and physical disabilities who (probably) didn’t identify with organized disability rights groups — who might rather die than be part of those groups. Let us consider the possibility that Track 1 MAID is being over-used and, in some instances, abused. Let us come to terms with the fact that many of these folks chose MAID rather than face existential loneliness and despair in their isolation and abandonment. Let’s light a candle for them.

And let’s honour the passing of 463 individuals who were not dying, but whose unnatural death was brought about (at their request) by doctors or nurse practitioners in 2022. Let’s add their memories to the 223 individuals who were not dying, but who died anyway, in 2021. Six hundred and eighty six individual people. To put names and faces to some of these numbers, visit our Remembering Lives Lived page. Let’s be sad for them, and not be ashamed of our sadness. Let’s think about better alternatives that could and should have been offered to each one of them. Let’s grieve, then get to work on pushing for those alternatives.

Your comments are welcome below.